Medical Cannabis — A Vastly Underutilized Therapeutic Option?

February 19, 2017
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Story at-a-glance

Cannabidiol (CBD) has been reclassified as a Schedule 1 controlled substance despite having no psychoactive component, meaning it cannot render you “high” and therefore has little potential for abuse

The human endocannabinoid system strongly suggests the human organism is actually designed to make good use of the cannabis plant

The primary role of the endocannabinoid system is to bring homeostasis to tissues and biological systems. Thus, the endocannabinoid system plays a key regulatory role in the human body

By Dr. Mercola

Cannabis is a vastly underutilized therapeutic option that has been wrongly vilified by U.S. regulatory agencies. In this interview, Dr. Margaret Gedde, a Stanford-trained pathologist and award-winning researcher, discusses the therapeutic value of this plant.

While initially focused on the conventional medical model, Gedde eventually transitioned over to holistic, drug-free health care in 2004. At present, she runs an alternative medical practice in Colorado, the home of medical marijuana, as it was one of the first states to widely legalize and apply it.

Gedde specializes in the use of cannabis, especially for the use of pain, thereby allowing her patients to get off dangerous drugs like opiates, which have created a public health emergency of massive proportions.

Drug Enforcement Administration Just Took a Huge Step Backward

We've come a long way in the U.S. when it comes to re-normalizing the use of medicinal marijuana. Unfortunately, the Drug Enforcement Administration (DEA) is still trying to suppress it as best they can.

This despite the fact that CBD has no psychoactive component, meaning it cannot render you "high." This is truly tragic when you consider the many medical uses for CBD. As noted by Gedde:

"It has been a real boon to have CBD available … CBD is not only non-psychoactive, it is remarkably non-toxic. Far less toxic than even over-the-counter medications that are commonly used.

The concept of putting CBD on the Schedule 1 of the drug schedule, saying that it has no medical use and is highly dangerous, just flies in the face of fact, science and knowledge. It's such a regressive move. It's certainly very disappointing …

[W]ith this move, they're not going in the right direction at all. They're definitely going backward. It's like a hostile act."

Indeed, the decision is so beyond irrational, the only justification I can see is that the DEA is influenced or controlled by the pharmaceutical industry. Making CBD — a non-psychoactive, non-toxic component with medicinal value — a schedule 1 drug benefits no one except the drug companies that have to compete against it.

There's absolutely no justification in a rational, science-based system for this decision. Ironically, synthetic tetrahydrocannabinols (THC) drugs, such as Dronabinol and Marinol, are listed as Schedule 3 drugs.

Rendering CBD Illegal May Create More Medical Refugees

The DEA's decision on CBD means that patients who live in states where medical marijuana is not permitted may again have to contemplate physically relocating to a state where CBD is legally available, such as Colorado, since it can no longer be shipped across state lines.

While not commonly discussed, there are in fact many such "medical refugees" in the U.S. Prior to the reclassification, CBD was freely available in all U.S. states, and could be easily obtained via mail order.

"The Department of Justice (DOJ) released a list of six priorities when the federal government is looking at states with medical cannabis laws, or just marijuana laws in general, where they wanted to be sure that product wasn't being shipped outside the state …

[T]hey wanted to be sure organized crime wasn't getting involved. They said if the states would stay within these guidelines and not be creating an interstate crime, then they would stay hands off. That's where we've been operating. We had the availability of CBD across state lines.

But now, with the new administration and the new year, the DEA is not going to allow the CBD to be shipped. Then we'll see if the priorities of enforcement change."

Cannabis Has Been a Boon to Colorado

Medical cannabis is very heavily taxed, and Colorado has seen enormous amounts of revenue flowing into the state with the legalization of marijuana. A big portion of that money is also given back as rebates to the residents of Colorado. So, from the state's financial perspective, it's been enormously effective and beneficial.

Colorado also allows the adult recreational use of marijuana. Interestingly, Gedde believes the impact of legalizing recreational marijuana has also been quite positive. For starters, if it's legal for adults to use marijuana, then it's easier for a person to seek medical cannabis.

"After it became legal for adults to use marijuana in Colorado, we saw more and more people coming into the clinic who had never used marijuana before," she says.

"As far as culture and society in Colorado, there are some people who don't like the number of shops … However, I think it actually has made a very positive change in the state.

There's data coming out … suggesting that in Colorado, specifically, and I think in general medical states, once there is greater availability of marijuana, the death toll from opiates goes down. We've also seen some data that there's less alcohol being used on the roads.

These are preliminary data. Some people would say 'This is too soon. You can't make those conclusions.' But actually, we really haven't seen problems.

There are rules against using marijuana in public, so people aren't supposed to be walking down the street smoking marijuana in any case. Things are really pretty calm and going smoothly. I think most people are pretty happy with the developments in the state with the marijuana availability in the laws."

Why Has Marijuana Been Vilified?

Smoking marijuana was once viewed as an act of political dissidence against the Vietnam War, and looking back at the history of what President Nixon was doing at the time, one can rightfully conclude that one of the reasons marijuana was so heavily targeted was to get rid of the hippies.

Marijuana became the fulcrum in the social battle of the day, and the U.S. government sought a means to take certain types of individuals out of society, and what better way than to arrest them and put them in jail? As noted by Gedde:

"[Marijuana has] been vilified all along. For what reasons? Maybe it does too much. It does have the psychoactivity, so people can change how they think and question things. When we look at cannabis overall, marijuana and hemp combined … all the different cannabinoids in there, we know that it's excellent medicine.

We know that it's popular recreationally, which of course competes with the alcohol industry. Hemp also provides excellent biofuel. It actually competes with the petroleum industry. It provides excellent fiber for clothing. It competes with lumber, which is one of the reasons apparently why hemp was restricted earlier in the 20th century …

Medicine, recreation, food, fuel and fiber. What else can do all those things? It's excellent food. Hemp oil has essential fatty acids. It's high-quality oil and it has high-quality protein. You can actually live on hemp seeds."

On Entering the Medical Marijuana System

Gedde was trained in the idea that molecular biology will provide us with all the answers we need. By understanding the details of how cells work, we'll be able to design a cure for every disease. However, once she found herself actually working inside the pharmaceutical industry, seeing how decisions were made, she came to realize the flaws of the system.

The fact of the matter is, drug companies have the legal mandate to turn a handsome profit. This in and of itself can create situations where profits are placed ahead of actual medical benefits. Moreover, when a company selects a product to develop, that product is not necessarily what is most needed. It's the thing that will make the most money.

"I realized there are non-pharmaceutical, non-patentable, more holistic and supportive options, such as … nutritional support, hormone balancing and neurotransmitter support. Instead of taking Prozac, how about some 5-Hydroxytryptophan (5-HTP)?

Those are things that naturopathic and alternative physicians are so familiar with and work with. That was not at all part of conventional medical practice. Certainly not the way I was trained. It was an epiphany. It was kind of a turning point in my career. It was a big thing to leave the pharmaceutical industry and open my first alternative practice," Gedde says.

She opened her medical practice in 2004, but it wasn't until 2009 that she began realizing the usefulness of cannabis. Initially, she learned from patients who were using it. They would tell her about how it helped heal their various ailments. Eventually she began researching it on her own, discovering the human endocannabinoid system in the process — a biological system not touched upon in medical school.

"When I started hearing the results patients were getting, I realized that the reason why [marijuana] could do so many different things in the body without being toxic is because it is acting through this natural endocannabinoid system in our bodies. That's when I said 'Wow. This is huge. There's nothing like this in medicine. There's nothing that I can prescribe that comes close to what this can do for people.'"

In 2010, she made the decision to focus on medical cannabis full-time — a decision she ascribes to careful deliberation of what actually helps patients the most.

The Endocannabinoid System

The human endocannabinoid system — endo meaning "within" — strongly suggests the human organism is actually designed to make good use of the cannabis plant. In other words, the marijuana plant triggers something that's been inside us since the dawn of mankind. The endocannabinoid system exists in other mammals as well, suggesting it is a truly an ancient biological system.

The cannabis plant makes cannabinoids, also known as phytocannabinoids or plant cannabinoids. This encompasses both CBD and THC, the latter of which is the psychoactive ingredient. In all, there are about 60 different cannabinoids in the cannabis plant, and medicinally, several of them are used. You also make cannabinoids inside your own body. So far, two major ones have been identified and studied since the early '90s.

The endocannabinoid system was first described in a science article in "The Journal of Science" in 1992. The primary role of the endocannabinoid system — which releases human cannabinoids that interact with receptors found in virtually all tissues in the body — is to bring balance (homeostasis) to tissues and biological systems.

Essentially, the endocannabinoid system plays a key regulatory role in the human body. For example, there are endocannabinoid receptors in the nervous system, where cannabinoids are made locally on demand. What this means is that, in your nervous system, you have sending nerve cells and receiving nerve cells, and the endocannabinoid system works with those cells to maintain balance.

For example, if the receiving nerve cell becomes too excited, you end up with a seizure. Seizures are due to uncontrolled electrical activity in the neurons. It's an overstimulated state. The endocannabinoid receptor detects this overstimulation and, on demand, makes human cannabinoids to dial down the sending impulses, thereby balancing the system.

Cannabinoids Benefit Your Entire Body

By bringing tissues back into balance, cannabinoids can reduce pain, nerve stimulation causing seizures, and muscle spasm. They also help you relax and improve sleep.

"[The endocannabinoid system] is a very key system. It totally makes sense why marijuana can do so many different things. It affects the mind. It affects the emotions. It affects the body on multiple levels. That's the THC. CBD does that as well. CBD has multiple targets in the body. The system seems very complex. There are multiple receptors.

It's not known how CBD acts. It acts in a different way from THC. There's much to research. But this is a very rich system, and it's very involved in our other body systems.

Those who write about this and report on it in the scientific literature frequently said that if this were being looked at for the first time, it would be in all the headlines. 'Hail. There's an incredible boon to mankind.' Because it can actually work through this natural system and do so many things without being toxic.

So many pain medications are damaging to the stomach, to the gut. The cannabis doesn't hurt the gut. It helps heal the gut. People are so relieved … There's nothing else that does that. It won't hurt the organs. It won't hurt the liver. It won't hurt the kidneys.

Ibuprofen … people can't stay on that for months and years. They can stay on cannabis. As we know as well, there is no known lethal dose for cannabis, whether it's THC or CBD. A person couldn't die from it even if they were trying really, really hard. There's nothing you can say that about. It offers so much to people on a medical level."

Cannabis Has Self-Limiting Effects

There is no fatal toxicity associated with cannabis. As noted by Gedde, the effects of THC and CBD are both dose-dependent. They have a bell-shaped response curve, which means there's a sweet spot where you get the benefit without any adverse effects. For THC, small, appropriate doses are relaxing and settle the stomach.

Too high a dose of THC will trigger anxiety. It can also cause nausea, confusion and/or disorientation. In severe cases, you might not know where or who you are. Temporary psychosis can also occur on high doses of THC. However, these effects are temporary and will resolve once the drug wears off.

Such side effects are actually helpful in that they cause cannabis use to become self-limiting. People don't want to feel terrible, so excessive doses are automatically discouraged by creating adverse reactions. Opiates, on the other hand, has no such feedback mechanism. People who take too high a dose simply die in a very relaxed state.

"With opiates, there's no point at which a person says, 'This is terrible. I don't want to do this.' There always needs to be more. With cannabis, it does have that self-limiting effect," Gedde says.

"We work closely with patients on the dosing. Less works; you want to start with lower. Because it is an oily medication and it does interact with the body in a different way, the cannabis can build up in the fatty tissues over time. We get this build-up effect that's very beneficial …

We explain this to patients to say, 'You could start at a certain dose. As you take that same dose day after day, it's going to build up for three to four weeks, so you could wait and see where the build-up effect gets you before you go to the next level.' That's, again, so that they're not using more than they need, not having extra side effects … The biggest thing we warn about is too-high doses of THC that would cause impairment and a very uncomfortable or unhappy experience."

Adverse Effects and Precautions

There is research in the medical literature suggesting that young people who already have a tendency to schizophrenia seem to receive a schizophrenia diagnosis sooner if they've been using marijuana. However, it's still not clear whether THC is actually causing or triggering the schizophrenia. That said, people with a family history of schizophrenia would be wise to use caution, and to work closely with an experienced doctor should they decide to try medical marijuana.

"Probably the biggest concern is simply that, in the developing brain in young people all the way up to the age of 25, the cannabinoids act on the brain. It seems THC can change brain development in such a way that — when a person is their 20s — that person would have a lower level of executive function, being able to plan and organize, and a little bit lower IQ," Gedde says.

"But there are battling studies going back and forth, where one would come out and say clearly 'Young people should not use this. Look at this correlation with bad outcomes.' And someone else will say, 'No. Look. You didn't control for XYZ. If we control this, we see that actually the reduced outcome correlates with socioeconomic status.'

As far as the cautions against adverse events, it really does relate to dose. Helping them to find the right doses that give them the benefits they need without adverse effect of too much, and just recognizing the psychoactive effect of the THC, especially for new users. But when we get the dose right, it could be very smooth and very productive."

Benefits of Cannabis and Specific Cannabinoids

As mentioned, CBD has no psychoactive activity, and has a long list of medicinal uses. It's an excellent muscle relaxer, easing spasms and pain. For this use, it can be applied topically, although edible versions tend to provide the deepest and most long-lasting relaxation and pain relief.

THC is famous for settling nausea associated with chemotherapy. According to Gedde, there's really nothing a doctor can prescribe that's as effective as THC for nausea. It also helps improve digestive function. For this reason, THC is particularly valuable for digestive disorders such as colitis and inflammatory bowel disease (IBD).

Cannabis has been shown to help glaucoma by reducing the intraocular pressure. It also helps normalize blood pressure, although that's not a valid medical indication for medical cannabis use in Colorado. As noted by Gedde:

"When you combine the body relaxation and the mental shifts — people talk about just being able to relax, it brings the stress down — this probably is part of how it helps blood pressure … But it does help normalize blood pressure so people are able to reduce their pills. That's actually one of the real cautions I do tell people about. If they're on blood pressure medication and they add the cannabis, their blood pressure can actually go too low. I alert them to peel back the blood pressure medications …"

Seizures are a classic indication of use, but you need to be very careful with the dosing when treating seizures. Gedde has found that CBD tends to be more difficult to use for seizures than THC, as too much CBD will exacerbate the seizures. HIV and cancer are other indications for use, as cannabis helps with sleep, nausea, pain and immune support, and has anti-tumor activity.

"The ones that aren't on the qualifying conditions list in Colorado would include the more psychological diagnosis. THC can induce anxiety if the dose is wrong or the strain is not compatible with that person. [Still], many use THC to relieve anxiety. Because we have hundreds of different strains of marijuana and cannabis, each of which is slightly different, there is a huge potential to customize [the drug] for each person."

Different Marijuana Strains Have Different Effects

In addition to cannabinoids, there's a whole other set of compounds in cannabis called terpenes — the same compounds found in essential oils. Terpenes are what give each marijuana strain its unique color and smell. Some strains smell like lemon. Other strains are purple and smell like lavender. In fact, the same terpene found in lavender, linalool, which gives lavender its calming, relaxing potential, is also found in many marijuana strains.

There's a whole range of marijuana strains known for their calming, sleep-inducing, relaxing properties, collectively known as "indicas." Indicas strains will not induce anxiety. They're relaxing and stress-reducing. The sativas are more stimulating and energizing, and resemble caffeine in this regard.

While helpful for anxiety and depression, sativas could produce paranoia and put you on edge, especially those with post-traumatic stress disorder (PTSD). When addressing the psychological spectrum, strain selection is very important.

"Post-traumatic stress is so difficult to treat. PTSD patients, the veterans, are a huge population we see. We're in Colorado Springs. There are military bases here. We see a lot of the veterans who had been overseas. Not only do they have all the physical injuries, but they have those psychological injuries. [They can benefit greatly] from choosing the correct strains and be able to actually get the benefit of that well-known property of THC where it causes forgetting.

THC is known to slow the mind down. You can't quite think about the things maybe that you were going to. For a lot of people, in a lot of settings, that would be an unwelcomed side effect. But when you have post-traumatic stress and you have intrusive thoughts, to have the mind slow down and those thoughts just don't break through and the nightmares don't break through, that's a huge boon. In post-traumatic stress, we see a lot of good results."

CBD and THC Work Very Well Together, Ameliorating Side Effects

Gedde stresses the point that CBD and THC work very well in combination, and while medical cannabis has been primarily THC-based, the availability of CBD has been a real boon, as CBD helps temper the psychoactivity of the THC.

"With hemp being grown now and CBD returning to patients, you can really use the THC in doses that are effective without the psychoactivity," she says. "We've been telling patients this is a huge boon for everyone. Get your CBD. Combine it with your THC. It's everywhere. It's not restricted like the THC.

Having this DEA action come out really puts that back on its heels for people who are not in a legal state. Here in Colorado, certainly we will continue to have CBD and THC, and continue working with them."

In closing, another point of note is that when the plant is unheated, meaning raw, it actually does not have THC in it. That's another one of its remarkable properties. The plant actually makes THC acid (THCA) and CBDA. So when you eat it raw, you get the THCA, not THC, which relieves pain and spasms. THCA is a synergizing agent, but it doesn't have the psychoactivity associated with THC.

This means you can consume marijuana raw and get health benefits without the psychoactivity. A number of doctors have become proponents of using raw cannabinoid as a dietary supplement. The key is to not heat the plant. If it were legal to use recreationally where I live I would grow it and regularly throw it in my smoothies.

Personally, I believe there are many still undiscovered benefits of taking cannabis therapeutically. There are no real downsides; no major adverse effects. Even the psychoactive side effects are only related to the heating of the plant, and even then they're temporary and largely self-limiting. The same cannot be said for opioids, which have overtaken cigarettes in popularity and kill tens of thousands of users each year, even when taken as prescribed.